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NPI Code Detail

MEDICARE: MR. JAMES WILSON SMITH JR. LMT

MEDICARE: MR. JAMES WILSON SMITH JR. LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMA0011524FL

General Provider Information

NPI Number : 1588645907
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES WILSON SMITH JR. LMT
Provider Business Mailing Address
First Line : PO BOX 651
Second Line :
City : SAFETY HARBOR
State : FL
Zip : 34695-0651
Country : US
Telephone Number : 727-215-9288
Fax Number : 727-724-9705
Provider Business Practice Location Address
First Line : 24945 US HIGHWAY 19 N
Second Line :
City : CLEARWATER
State : FL
Zip : 33763-3927
Country : US
Telephone Number : 727-215-9288
Fax Number : 727-724-9705
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2005
Last Update Date : 07/08/2007

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